Don’t Panic — You Can Still Use Artificial Sweeteners

Recent headlines about the artificial sweetener erythritol – warning it can cause a stroke or heart attack – may have you ready to give it up and go back to eating sugar.

Not so fast. Don’t toss your keto-friendly peanut butter fudge ice cream into the trash just yet. But don’t eat a gallon at a time, either.

Proceed with moderation. Let’s look at the facts.

What Is Erythritol?

Erythritol is an artificial sweetener that’s used in everything from power bars to chewing gum.

The erythritol you see in products at the grocery store is factory-made, usually from mashed, fermented corn, and is less sweet than table sugar.

It also occurs in nature organically.  Our bodies make small portions of it, and some fruits and vegetables, including mushrooms, contain a bit of it. The commercially made versions have been part of processed foods since 1990, starting in Japan. Dozens of countries now allow it in processed foods.

It’s a popular choice for many reasons, including:

• It’s less sweet than sugar
• It has close to no calories
• It doesn’t leave an unpleasant aftertaste
• It doesn’t cause cavities
• It causes fewer stomach upsets than some other artificial sweeteners
• It resembles table sugar
• It does not cause insulin or glucose levels to rise

That’s why food manufacturers often choose erythritol, alone or combined with another artificial sweetener such as monkfruit or stevia, to make their products taste and have a texture to foods made with table sugar. And it is being used more and more each year.

People on low-sugar diets, such as diabetics and cardiac patients, are especially drawn to products made with erythritol, as well as to snacks and drinks made with other artificial sweeteners. You might not know if it’s in the items you purchase, though. The U.S. does not require manufacturers to spell out erythritol on the ingredients list.

Why Are People Panicking?

The debate over whether erythritol is safe began after Nature Medicine published a study that, at first glance, contains shocking conclusions.

It claims that erythritol causes the platelets in your blood to clot, and by a big amount. When those blood clots travel to your heart, they can cause a heart attack. When they move up to your brain, they can cause a stroke. The study says erythritol forms these potentially lethal clots rapidly, so a clot might quickly get very large.

For the most part, the study looked at the blood of people who already have medical challenges, such as those with heart issues. Still, researchers did test a few low-risk volunteers. When they drank a beverage that contained 30 grams of erythritol, they had a spike of the substance in their blood that lasted for up to three days. The spike was big — 1,000 times more than they had beforehand.

The study has flaws. It is not yet clear if eating or drinking items with erythritol will actually hurt you. Further studies need to examine which people are most at risk; how much erythritol it’s reasonably safe to consume; and if erythritol is more dangerous for those whose diet in general is made up of unhealthy foods than wholesome ones.

In the long run, the scientific community might indeed find that none of us should eat or drink prepared items that contain erythritol. But we’re not there yet.

How To Eat Healthfully

Talk to your doctor if you eat a lot of artificially sweetened foods. Diabetics, heart patients, people on ketogenic diets and anyone else who regularly snacks on sweetened processed foods made with something other than sugar should get medical advice about these choices.

If you do not fit into one of those categories, it’s OK to have some foods with erythritol or other artificial sweeteners. But eat mindfully, starting with these tips:

• Keep your quantities small. If you crave a sweet and don’t want sugar, have one reasonable portion of whatever you choose. A pint of keto-friendly ice cream has more erythritol than anyone should consume in one sitting. Instead, fill a one-cup bowl with some and put the rest in the freezer for another time.
• Choose whole foods, not processed. Sugar is in most processed foods, and many others have artificial sweeteners, including erythritol. Processed foods also have artificial colorants and preservatives. Try to eat foods that come from nature instead. When looking at labels in the supermarket, go by the rule, “If you can’t pronounce the ingredient, it’s probably not good for you.”
• Break that rule in moderation. If you’re watching your weight, heart or blood sugar, and you like diet soft drinks, treat yourself to one a day, but not six a day. Drink water the rest of the time. The use-it-sparingly advice goes for everyone and refers to any artificially sweetened food or beverage.
• Use alternatives. Skip the bottle or can of processed iced tea, no matter how it’s sweetened. Drink unsweetened iced tea, and maybe add a dash of sugar or artificial sweetener. Flavored seltzers are another alternative.
• Live within the lines on weekdays. Choose natural, low-fat, unsweetened and unprocessed foods as much as possible Monday through Thursday. Have a cheat day every Friday, or maybe Friday through Sunday. That’s more tolerable than never.

As research continues, we will learn more about erythritol. In the meantime, proceed cautiously. Moderation is your friend.